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This is an important paper written by Steven Coles and colleagues about psychiatric diagnosis. What do you think? Have your say!

What is your Opinion of Psychiatric Diagnosis?

What is your view on psychiatric diagnosis? Should the diagnosis of schizophrenia be abolished as the Campaign for the Abolition of the Schizophrenia Label wish? For both those working in mental health services and those on the receiving end, how important is diagnosis to your life? There are many different views on psychiatric diagnosis from fierce advocates to those who decry the practice. A number of survivors, academics, professionals, and service users have criticised diagnosis. However, within mental health services psychiatric diagnosis remains dominant. Psychiatrists (and other professionals) claim they use diagnosis to understand people’s experiences, behaviour and distress. Diagnosis shapes how services are organised, who will be helped and how services will support or “treat” people. Psychiatric diagnosis also has a major impact on whether people are detained against there will in hospital – the civil liberties of people with a psychiatric diagnosis are at a greater risk than anyone else in society (other than suspected terrorists). Diagnosis influences whether people are forced to take major tranquilizers (“antipsychotics”), and whether they receive financial benefits.

Despite the immense controversy surrounding diagnosis, my experience is that the debates around diagnosis are not openly discussed between staff or with people using (or forcibly brought into) mental health services. Psychiatric diagnosis has become an everyday and often unquestioned part of mental health practice. Is this simply because critics of diagnosis have weak arguments? Is it because the scientific basis of psychiatric diagnosis is so strong? Is there no alternative? A group of Clinical Psychologists working in East Midlands Adult Mental Health Services have looked at the issue of psychiatric diagnosis and written a position paper (Coles & SPIG, 2010). They conclude that “psychiatric diagnosis does not meet its scientific and expert claims” and does not deserve to be so dominant in mental health services.

The East Midlands group highlighted a number of negative effects of psychiatric diagnosis. They note that diagnosis places the cause of difficulties on the individual; the group feel more attention should be paid to people’s life experiences, such as abuse, poverty, discrimination and disempowerment. The position paper also observes that the language of diagnosis is barrier to communication between staff and people using services. Furthermore, diagnosis is not aware that it is based upon dominant western (often male) ideas of what is normal, and ignores that other cultures and subcultures might have different or a broader idea of what is normal. The paper also notes some modest alternatives to moving beyond diagnosis (for access to the document see www.bps.org.uk/dcp-sigpr/publications-%26-documents/publications_home.cfm).

The East Midlands Paper is accessible at the above link, as well as on the Hearing Voices Network website. The group is hoping to open up a debate around diagnosis and would welcome people’s thoughts on the paper and on diagnosis. The East Midlands paper suggests that the current dominance and use of diagnosis is part of the problem and not part of the solution as psychiatry claims. What do you think? What is your experience of diagnosis?

References

Coles, S. & SPIG (2010). Position on Psychiatric Diagnosis. East Midlands: Psychosis and Complex Mental Health Special Interest Group

Psychology, Mental Health and Distress is a groundbreaking new text from John Cromby, David Harper and Paula Reavey. Whereas other texts are structured by diagnostic categories and are biologically reductive, this book places biology as well as the experience of distress itself in its social, cultural and historical context.

Key Features:

Offers a wealth of case stories to portray the reality of living with distress and stimulate class discussion

Fully informed by current experimental, qualitative and theoretical psychological research including research into hearing voices

Includes a chapter authored by those with first-hand experience of mental health services, ensuring your students understand the nuances of this emotionally charged and often controversial topic

Features additional contributions by renowned figures including Professor Richard Bentall, Professor John Read, psychiatrist and researcher Joanna Moncreiff and campaigner and Chair of the Hearing Voices Network, Jacqui Dillon among others.

Demedicalising Misery: Psychiatry, Psychology and the Human Condition. Co-edited with Mark Rapley and Joanna Moncrieff. Published by Palgrave Macmillan.

Thomas Szasz (1960) suggested that the myth of ‘mental illness’ functions to ‘render more palatable the bitter pill of moral conflict in human relations’. The medicalization of distress enables the mental health professions to manage the human suffering that they are confronted with, and also the suspicion that there is little that they can do to help. But the medicalization of misery and madness renders people unable to comprehend their experiences in ordinary, meaningful terms. In this collection we restore to everyday discourse a way of understanding distress that, unlike contemporary psychiatry and psychology, recognises and respects the essential humanness of the human condition. De-medicalizing Misery is a shorthand term for this project. The book resists the psychiatrization and psychologization of human experience, and seeks to place what are essentially moral and political – not medical – matters back at the centre of our understanding of human suffering.

Notes on Contributors
Preface; R.DallosCarving Nature at its Joints? DSM and the Medicalization of Everyday Life; M.Rapley, J.Moncrieff & J.DillonDualisms and the Myth of Mental Illness; P.Thomas & P.BrackenMaking the World Go Away, and How Psychology and Psychiatry Benefit; M.BoyleCultural Diversity and Racism: An Historical Perspective; S.FernandoThe Social Context of Paranoia; D.J.HarperFrom ‘Bad Character’ to BPD: The Medicalization of ‘Personality Disorder’; J.BourneMedicalizing Masculinity; S.TimimiCan Traumatic Events Traumatise People? Trauma, Madness and ‘Psychosis’; L.JohnstoneChildren Who Witness Violence at Home; A.VetereDiscourses of Acceptance and Resistance: Speaking Out About Psychiatry; E.SpeedThe Personal Is the Political; J.Dillon‘I’m Just, You Know, Joe Bloggs’: The Management of Parental Responsibility for First-Episode Psychosis; C.Coulter & M.RapleyThe Myth of the Antidepressant: An Historical Analysis; J.MoncrieffAntidepressants and the Placebo Response; I.KirschWhy Were Doctors so Slow to Recognise Antidepressant Discontinuation Problems?; D.DoubleToxic Psychology; C.NewnesPsychotherapy: Illusion With No Future?; D.SmailThe Psychologization of Torture; N.PatelWhat Is To Be Done?; J.Moncrieff, J.Dillon & M.RapleyFigure: Papers Using Term ‘Antidepressant’ On Medline 1957-1965
Index

‘Despite longstanding awareness of the limitations of the medical model when applied to difficulties of human behavior and adjustment, the fields of psychiatry and psychology continue to accede to the pressures of medicine and the drug industry in their conceptualization of these human realities. Ironically, however, this medical model, eager as it is to fit so much of people’s experience into diagnostic categories, is a social construction. This book represents a significant effort to de-mystify, de-medicalize, and reclaim important aspects of the human condition.’ – Kenneth D. Keith, Professor, Department of Psychological Sciences, University of San Diego, USA

‘De-Medicalizing Misery has assembled an impressive cast of leading mental health experts. Together they challenge the simplistic and pessimistic biological model of human distress that has, with eager support from the pharmaceutical industry, dominated the mental health field for far too long. This evidence-based, humane and optimistic book not only explains where biological psychiatry went wrong, it spells out the alternatives.’ – John Read, University of Auckland, New Zealand and Editor of ‘Models of Madness’

‘The psychiatrist or psychologist is expected to do something for every patient sitting in front of him or her, but how robust is the intellectual basis of psychiatric science when psychiatric ‘diseases’ are merely symptom clusters – clustered by us, not by nature? We are in indeed in the age of the medicalization of everyday life, when Lord Layard, economist and architect of the IAPT programme, can write in the BMJ that ‘mental illness’ has taken over from unemployment as our greatest social problem. But what is the test of ‘mental illness’? In DeMedicalizing Misery the authors examine some of the domains lamentably absent from orthodox psychiatry and psychology training programmes, with their medical model focus, and in so doing raise the IQ of the whole debate. And not just for clinicians.’ – Dr Derek Summerfield, Consultant Psychiatrist & Senior Lecturer, Institute of Psychiatry, King’s College, London, UK.

Authors: MARK RAPLEY is Professor of Clinical Psychology at the University of East London, UK. He is the author of The Social Construction of Intellectual Disability, Quality of Life Research and, with Susan Hansen and Alec McHoul, Beyond Help: A Consumers’ Guide to Psychology.

JOANNA MONCRIEFF is Senior Lecturer in the Department of Mental Health Sciences at University College London, UK and a Practising Consultant Psychiatrist at the North East London Foundation Trust. She has spent her academic career re-evaluating the nature and efficacy of psychiatric drugs and exploring the history and politics of psychiatry. She is the co-chair of the Critical Psychiatry Network, and has campaigned against the dominance of the biomedical approach to psychiatry, the extension of psychiatric coercion and the influence of the pharmaceutical industry, in alliance with service user groups. She is the author of The Myth of the Chemical Cure (Palgrave Macmillan), A Straight Talking Introduction to Psychiatric Drugs, and numerous papers and book chapters.

JACQUI DILLON is the National Chair of the Hearing Voices Network, UK, and a Director of Intervoice – the International Network for Training, Education and Research into Hearing Voices. She is a campaigner, international speaker and trainer specialising in hearing voices, psychosis, dissociation and trauma. She is the co-editor of Living with Voices: An Anthology of 50 Voice Hearers’ Stories of Recovery. She has published numerous articles and papers, is on the editorial board of the journal Psychosis: Psychological, Social and Integrative Approaches and is a member of the collective for Asylum, The Magazine for Democratic Psychiatry.

I have known Jacqui Dillon for several years now — we first met in the early 2000s when she attended the London-based Critical Mental Health Forum, in which I was also involved. Jacqui has been an extremely effective developer of services in the third sector. She developed the London Hearing Voices Project and has also chaired the national Hearing Voices Network for several years.

She is a thoughtful and innovative worker who builds good collaborative relationships both with those who use mental health services and with mental health professionals. She has also been very effective in securing funding for those organisations with which she works.

I work on a clinical psychology training programme and Jacqui has taught sessions on a range of topics on our programme for several years now. Trainees have said that she is a very engaging and inspiring speaker who also has lots of practical advice about how to bring change in mental health services.

When I’ve seen Jacqui speak I also have been moved and inspired. Given her earlier career as a journalist it is no surprise that she has been doing more writing, recently co-editing Living with Voices. She has a national and international reputation and is approached by a range of media organisations for comments in relation to voice hearing and mental health more generally.

Dr Dave Harper, Reader in Clinical Psychology, University of East London. Academic Tutor on the Doctoral Degree in Clinical Psychology programme.

Welcome

Jacqui Dillon is a writer, campaigner, international speaker and trainer. She has personal and professional experience, awareness and skills in working with trauma and abuse, dissociation, ‘psychosis’, hearing voices, healing and recovery.